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4K Blood Test vs MRI Fusion Biopsy

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Posted 8/2/2019 6:46 PM (GMT 0)
Hi all. I’m 59, and I met with my urologist this morning. After several years of monitoring my PSA levels, he recommended that I have a MRI Fusion Biopsy. I think that is the right term. He said I would have an MRI, after which I would have a biopsy that would utilize the MRI. I previously had a regular biopsy about 5 years ago, and I’m not looking forward to it. The first 5-6 pokes weren’t too bad, but I was feeling pretty beat up by the time we got to the end. My urologist knows this, so he said I could do a 4K blood test instead. He said, if it were him though, he’d do the biopsy.

As I said, I’m 59 and my PSA has gone from 2.4 to 4.0 over the last 2 years, giving me a velocity of 0.1 NG/ml/mo. (Not sure that really matters based on what I have read today.) I had my first biopsy in January of 2014 after an apparently aberrational PSA test yielding a 5.3. My PSA settled down after that and then started a steady climb to where it is now.

I have the usual urinary symptoms and some pain, but nothing else.

I’d be interested in your thoughts as to whether I should bite the bullet and go for the biopsy or do the 4K blood test. My concern about the blood test is that it may miss something.
Posted 8/2/2019 8:28 PM (GMT 0)
Hi Rich:

Having a 4K test is your situation is not an unreasonable choice. It will tell you with pretty good accuracy your risk level of having Gleason 7 cancer or above. It will not tell you if you have Gleason 6 cancer or how much of it you might have. Also, last time I looked the 4K test was not covered by Medicare so you might want to check to see if YOUR insurance covers it.

Re the biopsy, given it's MRI driven it's more likely to give you a good indication of any cancer you may have and the grade. If you had trouble with the biopsy last time you can ask for IV anesthesia (which I did) and it's a lot easier on you.

Good luck and let us know what happens.

Jim
Posted 8/2/2019 9:57 PM (GMT 0)

Rich54 said...

I have the usual urinary symptoms and some pain, but nothing else.


What do you mean by this? It is not "usual" to have pain when urinating, or any other "symptoms."

Your are correct that PSA doubling time is NOT meaningful or informative in untreated men because there are multiple likely contributors to PSA in your blood...and it sounds (based on your comment above) like you've got some of that going on. You should try to eliminate that, first...I would not suggest jumping to a biopsy without that, first. Advanced PC could cause those symptoms...you do NOT have advanced PC; you've got something else going on and there are several possible causes. Did you tell your urologist about these "symptoms?"

Here's the thing...you probably DO have some low-level PC simply because it is a natural part of aging. about 60% of 60-year olds have it, and most never know about it and it never affects them...if they did discover it (based on running into circumstances which lead to a biopsy), the most of them would be the low-grade PC which no treatment is recommended. The 4K test sounds like a good next step for you; not biopsy. (Yes, another biopsy very well may be in your future...not now.) Before jumping to the 4K, did your PSA test also provide a "free PSA" result? You may have additional informative info before doing anything else. Don't rush...

Post Edited (Blackjack) : 8/2/2019 4:01:00 PM (GMT-6)

Posted 8/2/2019 10:20 PM (GMT 0)
Blackjack - I wasn’t clear. I meant that I have the usual urinary symptoms (weak stream, trouble starting, 4 wake-up calls per night, etc.) and, separately, some pain that appears to radiate from my prostate. My free PSA is 15%.

Thanks for taking the time to reply.
Posted 8/3/2019 2:21 AM (GMT 0)
You have BPH.
Causes elevated PSA.
Google it.
No to biopsy.
Posted 8/3/2019 2:31 PM (GMT 0)
Another blood test to look into is the PHI (prostate health index).

It's not unreasonable to get more blood work before committing to the biopsy. It also reasonable to follow your doc suggestion and get the biopsy. If you do go that way, ask for anesthesia. Makes it a more tolerable procedure.

Remember that any blood tests will not confirm PC, only give an indication of risk that can be used to help decide if you need a biopsy.

The PSA velocity prior to treatment isn't all that useful. It could be from PC, but BPH might explain it. You can't be 100% sure. However, a slowly increasing PSA is sometimes a precursor to a PC DX.

Sadly it's one of those choices you'll have to make.

Do keep us updated on your progress.
Andrew
Posted 8/3/2019 8:29 PM (GMT 0)
If me, I'd have 4K and PHI blood tests before committing to anything.
Posted 8/3/2019 10:10 PM (GMT 0)
Your up and down PSA (you called it “aberrational“) is yet another indication of benign contributors (like BPH).

Hey, though, if you’ve been reading up on PC, then you already know that “weird cells” in the prostate is a natural part of aging..,and that they call the very commonly occurring low-grade variety of it “cancer,” even though it has no metastatic potential. Mistakenly they gave it the same label as the rare lethal kind of prostate cancer...go figure.

So if you’ve been reading, you also know 60-year olds have about 60% chance of something findable/diagnosable if you go looking hard enough. After age 50 the percentage likely is roughly equal to your age. You prob have some low-grade aging “cancer” plus BPH. So, look hard enough for the cancer and you’ll probably find something (that’s a rule of thumb)...but then that puts you on the slippery slope.

I’d focus on addressing your known BPH symptoms...

Good luck.

Post Edited (Blackjack) : 8/3/2019 4:14:12 PM (GMT-6)

Posted 8/3/2019 10:20 PM (GMT 0)
The aberrational PSA was the 5.3 back in 2014. Since then, my scores came down to the 2.4 range, but have gone up steadily over the last two years, from 2.4 to 4.0. Over the last two years, It has been a steady climb averaging about .6 every 6 months.
Posted 8/4/2019 2:44 AM (GMT 0)
Yup, saw that
Posted 8/4/2019 3:55 PM (GMT 0)
Rich - has your doctor diagnosed BHP or other prostate issue?

I see no reason not to proceed with at 4k or PHI test. Neither will confirm or deny PC, but might help point the right direction.

and I'd pay more attention to my doctor's advice than a random group of people on the internet.

Andrew
Posted 8/4/2019 4:09 PM (GMT 0)
I couldn’t agree more with InTheShop’s comment...at least that final sentence. But of course you aren’t at a random internet site...this site is filled with peer-to-peer knowledge about prostate issues (some inputs better than others...that’s the random part).

A good doctor will tell you to eliminate non-cancerous causes first.

Here’s a questionaire on the symptoms you’ve said you are experiencing. What’s your score?
https://www.uptodate.com/contents/calculator-international-prostatism-symptom-score-ipss
Posted 8/4/2019 9:45 PM (GMT 0)
bj you're random
Posted 8/7/2019 2:48 PM (GMT 0)
Come on Andrew ... BJ can diagnose BPH over the internet AND recommend treatment. Super powers has he.
Posted 8/7/2019 3:26 PM (GMT 0)
Ya damm right!
And they said Batman had no superpowers.



But in this case, good thing we didn't step in it.
Posted 8/8/2019 12:59 AM (GMT 0)
I have been dealing with AS and various test results for over ten years, and would offer the following suggestions.

Have a PHI test followed by a 3T mp-MRI.

If those find suspicions that justify a biopsy, then have it. Both NIH and JH now use the Precision Point transperineal system as their only device for prostate biopsies. No more antibiotics or infections. An exam room with local anesthesia are all that is required.

Take one step at a time. Good luck.
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